Revenue Cycle Management
Healthcare Blog

Revenue Cycle Management, Way Downstream

Revenue Cycle Management Downstream resized 600Two of the companies within my organization -- VARO Healthcare and BYL Collection Services -- service patient pay accounts receivable and patient pay bad debt.

These service points seat us at or about the end of the line in a typical provider’s revenue cycle. Because the work we do is residual (we primarily work what’s outstanding), we don’t always see revenue cycles cradle to grave. However, our view at the end of revenue cycles allow us to see some things that could’ve or should’ve been. 

I wrote this blog to share insights that may help providers with their efforts to enhance revenue cycle results.

Healthcare providers should consider the following:

  • Find ways to excel at origination/registration. The integrity of data captured at origination positively or negatively affects:

    • A provider’s ability to quickly and effectively move claims through a logical revenue cycle progression (payer -> payer -> patient)

    • The number of corrective actions and touches/retouches required to take a claim cradle to grave (think about the number of activities involved in curing a denial)

      • Business self-assessment is a terrific tool for breaking registration down into parts so that you can measure what’s working and what’s not (check out: Stop Chasing Fires: BSA for Revenue Cycle Management
      • Employee scorecards are another terrific tool to consider for managing the performance of registration desk employees. Scorecards are terrific because they utilize objective peer performance to establish line item benchmarks for job performance. If they’re set up the right way, scorecards can help managers and team leaders identify the strengths and weaknesses of individual employees – a great coaching tool.
        • One quick note about employee scorecards: stress levels tend to go up with the thought of publishing the results of individuals (results with names). My experience says after some bumps, employees grow to love scorecards for three reasons: 1) top performers get a chance to show people the great work they’re doing 2) employees can objectively see aspects of their job that they should work on to improve and 3) employees can objectively watch their progress (the results of their efforts to improve).

  • Stratify accounts and treatments.  Successful revenue cycle management isn’t just about executing multiple treatments. Successful revenue cycle management is really about executing the right treatment at the right time coupled with quick and easy account movement. Comingling accounts and/or ineffective workflows means:

    • Revenue cycles will protract because accounts will require added stops for all treatments

    • The added stress of having to filter out what doesn’t belong will adversely affect the performance of revenue cycle teams

      • It’s worthwhile to invest time in work design (check out an Insider's Guide to Building Better Work Design). Work design lays out the plan on paper and forces Revenue Cycle Teams to think through the logical labeling of account segments and the logical movement of accounts through workflows.

  • Build upstream feedback channels. Letting information flow from the end of the process back to the front of the process is a great tool for facilitating process improvement. Failure to create an upstream information channel means:

    • Without awareness or accountability, front-end operations (registration) will continue to make the same mistakes (over and over)

    • Growth of the organization will require added (abnormal) expenses to further support inefficient processes (more people to fix broken processes) 

      • Reporting that captures volumes, frequency, benchmarks, and trends over time moves upstream report outs away from complaint sessions and towards objective problem solving.

      • Shared goals (and perhaps shared incentives) targeting key performance indicators (denial rates, collection rates, bad debt rates) go a long way towards pulling areas of responsibility (like registration and revenue cycle teams) together.

As always, I’m interested in comments, questions, or feedback. Please feel free to contact me anytime.

Phone: (484) 459-8723, e-mail:, or on LinkedIn.

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Topics: healthcare receivable management, Revenue Cycle Management